January 14, 2020

The Healthcare Crisis

By JR Martin


According to a recent Gallup poll, medical costs are still among the top worries that we experience as Americans. It seems we fear the costs associated with accidents and disease as much as the problems themselves. 

Healthcare costs are a hot topic. Democrats and Republicans alike seek to navigate us out of our healthcare crisis. As in any critically lost situation, we are left to wonder about how we got here and to worry about how we get out. Reflecting on my personal experiences and reviewing the data have helped me. I hope it helps you. 

As a young man growing up in the ’80s (complete with a mullet and ’80s music blaring on the radio), I remember my father working long hours in the emergency room in American Fork, Utah. He loved it. The sense of community and service was profound. At that time, the hospital still seemed to be true to its 1937 beginnings. The original property cost was $2,500 and half of that amount was raised by the community. This was their hospital. 

As the community grew, so did the hospital. The roaring ’50s brought a new location and updated facilities, which doubled the number of patient beds. During the decades between the hospital’s original construction and the 1950s, the ratio of administrators to physicians remained consistent. However, the ’60s and ’70s brought a change. Administration began to grow and outpace the physician population substantially. I still remember the day in the ’80s when my father said that the new hospital had the same number of patient rooms but had doubled or tripled the space for administration. 

Beginning in the ’90s, the percentage of administrators compared to physicians skyrocketed. The cost of healthcare skyrocketed as well. The new century has seen a dramatic increase in non-clinical healthcare workers. Perhaps this also adds fuel to our skyrocketing costs. According to an analysis published in the Journal of the American Medical Association (Berwick, Joynt and Shrank, JAMA 2019:dpi/1001), researchers stated that “administrative complexity was responsible for $265.5 billion of waste.” It is interesting to note that the researchers were unable to find studies that focused on interventions targeting administrative complexity. 

The lack of any studies focusing on how to decrease administrative costs reminds me of an interview I watched between a journalist and an expert medical economist. The medical economist had spent years in Washington analyzing medical economics. At the conclusion of the extensive interview, which covered a myriad of medical economic situations and scenarios, the researcher simply asked, “So why are medical costs too high?” The economist responded, “They are high because we charge so much.” There was a long, awkward pause, and the journalist nodded her head as if trying to wrap her mind around the obvious. The journalist continued, “(If) healthcare is so expensive because we charge so much, then how many discussions are there in Washington about cutting costs?” The researcher responded, “None, because no one is interested in making less money.” 

Now what? I have noticed that mullets are coming back! ’80s music is still playing loud and clear on some local channels. I believe we still have an amazing community of amazing individuals who want to take healthcare back into their own hands and are willing to pay for it. What do you think? 

I welcome your suggestions on Alive & Well’s Facebook page. Together, I think we can find our way out! We can guide our community. Look for my live presentation containing the graphs you see in this article. I will be looking for your comments.


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